Gastroesophageal Reflux Disease (GERD)/Heartburn

What is GERD?

GERD (gastroesophageal reflux disease) is a digestive disorder. It is caused when
gastric acid from your stomach flows back up into your food pipe or esophagus.

Heartburn is the most common symptom of GERD.

What causes GERD?

GERD happens when gastric acid from your stomach backs up into your food pipe or esophagus.

A muscle at the bottom of the esophagus opens to let food in and closes to keep food
in the stomach. This muscle is called the LES or lower esophageal sphincter. When
your LES relaxes too often or for too long, acid backs up into your esophagus. This
causes heartburn.

Some lifestyle issues that can cause GERD may include:

Being overweight

Overeating

Eating foods such as citrus, chocolate, and fatty or spicy foods

Having caffeine

Having alcohol

Smoking

Using aspirin and over-the-counter pain and fever medicines (nonsteroidal anti-inflammatory
drugs or NSAIDs)

Some health problems that may cause heartburn may include:

Gastritis, a redness or swelling (inflammation) of your stomach lining

Ulcers, painful sores on the lining of your stomach, esophagus or the first part of
your small intestine (duodenum)

Who is at risk for GERD?

You may be more at risk for GERD if you:

Have a hiatal hernia

Have a weak lower esophageal sphincter or LES

Are obese

Are pregnant

Use some medicines, such as aspirin or over-the-counter pain and fever medicines (nonsteroidal
anti-inflammatory drugs or NSAIDs)

Smoke or are around secondhand smoke

Drink alcohol

Are older

What are the symptoms of GERD?

Heartburn, also called acid indigestion, or acid reflux, is the most common symptom
of GERD. Heartburn is a burning chest pain that starts behind your breastbone and
moves up to your neck and throat. It can last as long as 2 hours. It often feels worse
after you eat. Lying down or bending over can also cause heartburn.

Another common symptom of GERD is regurgitation. Some people can have trouble swallowing.

Heartburn is not a GERD symptom for most children younger than 12 years old, and for
some adults. They may have a dry cough, asthma symptoms, or trouble swallowing instead

Each person’s symptoms may vary. GERD symptoms may look like other health problems.
Always see your healthcare provider to be sure.

How is GERD diagnosed?

To see if you have GERD, your healthcare provider will give you a physical exam and
ask about your past health.

Some people with typical symptoms may be treated without further testing.

Other tests for GERD may include the following:

Upper GI (gastrointestinal) series, also called a barium swallow. This test looks at the organs of the top part of your digestive system. It checks
your food pipe (esophagus), stomach, and the first part of your small intestine (duodenum).
You will swallow a metallic fluid called barium. Barium coats the organs so that they
can be seen on an X-ray.

Upper endoscopy or EGD (esophagogastroduodenoscopy). This test looks at the lining or inside of your esophagus, stomach, and duodenum.
This test uses a thin, lighted tube, called an endoscope. The tube has a camera at
one end. The tube is put into your mouth and throat. Then it goes into your esophagus,
stomach, and duodenum. Your healthcare provider can see the inside of these organs.
He or she can also take a small tissue sample (biopsy) if needed.

Bernstein test. This test helps to see if your symptoms are caused by acid in your esophagus. The
test is performed by dripping a mild acid through a tube placed in your esophagus.

Esophageal manometry. This test checks the strength of your esophagus muscles. It can see if you have any
problems with backward flow of fluid (reflux) or swallowing. A small tube is put into
your nostril, then down your throat and into your esophagus. The tube checks how much
pressure your esophageal muscles make when they are at rest.

pH monitoring. This test checks the pH or acid level in your esophagus. A thin, plastic tube is placed
into your nostril, down your throat, and into your esophagus. The tube has a sensor
that measures pH level. The other end of the tube outside your body is attached to
a small monitor that records your pH levels for 24 to 48 hours. During this time you
can go home and do your normal activities. You will need to keep a diary of any symptoms
you feel, and also of the food you eat. Your pH readings are checked and compared
to your activity for that time period.

How is GERD treated?

Your healthcare provider will make a care plan for you based on:

Your age, overall health, and past health

How serious your case is

How well you handle certain medicines, treatments, or therapies

If your condition is expected to get worse

What you would like to do

In many cases making diet and lifestyle changes can help reduce GERD symptoms. Always
check with your healthcare provider before making any changes.

If you have GERD, be careful about what you eat and drink. Don’t have too much of
the following:

Fried and fatty foods

Peppermint

Chocolate

Alcohol

Citrus fruit and juices

Tomato products

Drinks with caffeine, such as coffee, soda, and energy drinks

You should also:

Eat smaller portions

Not overeat

Quit smoking

Not drink too much alcohol

Wait a few hours after eating before you lie down or go to bed

Lose weight if needed

Raise the head of your bed 6 inches by putting bricks or cinderblocks or bedrisers
under the bed legs under the head of the bed

Be sure to check any medicines you are taking. Some may cause problems with the lining
of your stomach or esophagus. You may also want to talk to your healthcare provider
about:

Taking medicines to reduce your stomach acid (antacids)

Taking medicines called H2-blockers and protein pump inhibitors. Taking these medicines
before eating may stop heartburn from happening.

Taking medicines that help to empty food from your stomach (promotility medicines).
You will need a prescription for these. However, these medicines are rarely used to
treat reflux disease unless there are other problems, too.

Having surgery called fundoplication. This is sometimes done to help keep the esophagus
in the right place and to stop the backward flow of fluid (reflux).

What are the complications of GERD?

If GERD is not treated, it can lead to other health problems. These may include:

Esophagitis. This is an irritation of the esophagus caused by the acid in your stomach contents.

Narrowing of the esophagus, also called strictures. This can make it hard to swallow.

Barrett’s esophagus. This affects the lining of your esophagus. In some cases it can lead to esophageal
cancer.

What can I do to prevent GERD?

Some of the same diet and lifestyle changes that are used to treat GERD can also help
to stop it from happening.

Living with GERD

Your healthcare provider will give you advice on how to manage your GERD symptoms.
In most cases you will need to make some diet and lifestyle changes so that GERD pain
won’t get in the way of your normal activities.

When should I call my healthcare provider?

Call your healthcare provider if your GERD symptoms don’t improve with treatment or
they get worse. Also call if you have new symptoms.

Key points

GERD (gastroesophageal reflux disease) is a digestive disorder. It is caused by gastric
acid flowing from your stomach back up into your food pipe (esophagus).

Heartburn is the most common symptom of GERD.

Some lifestyle issues that may cause GERD include being overweight, overeating, having
caffeine and alcohol, and eating chocolate and spicy foods.

There are several tests that can be done to see if you have GERD.

If it is not treated, GERD can lead to other health problems.

Making diet and lifestyle changes can help reduce GERD symptoms.

Some medicines may also help reduce symptoms.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

Before your visit, write down questions you want answered.

Bring someone with you to help you ask questions and remember what your provider tells
you.

At the visit, write down the names of new medicines, treatments, or tests, and any
new instructions your provider gives you.

If you have a follow-up appointment, write down the date, time, and purpose for that
visit.